IIt is rare for a politician to openly admit that he is divided on an issue, but there have been two striking examples in recent days. Firstly, Wes Streeting, Labour’s shadow health secretary, admitted that although he had voted to legalize assisted dying a few years ago, he feels conflicted. Then Nicola Sturgeon, former First Minister of Scotland, wrote a piece saying that with new Scottish legislation on the table, the reservations she expected to be removed will disappear. getting stronger.
Last year I wrote about my own journey regarding proposals to legalize physician-assisted suicide for the terminally ill. Ten years ago I would have supported assisted dying, out of respect for personal autonomy and a desire to alleviate suffering. Today I understand that these goals are not isolated, but must be weighed against the impact on those for whom an abstract liberal idea like autonomy is deeply simplistic, and against the state-sanctioned wrongful deaths that seem to me impossible to avoid.
The initial trigger for my reappraisal was my evolving understanding of the complexity of relationships. We are not all autonomous islands floating in a sea of humanity; we are deeply influenced by each other and by cultural norms. Writing about domestic violence has opened my eyes to the extent that coercive control of relationships drives people to do things because others want them to. Of course, there will be women who receive a terminal diagnosis, whose partners emotionally abuse them for years – telling them that their lives are not worth living – who will be under unbearable pressure to choose assisted dying. How can we ignore that an estimated one-third of suicides occur among women? related to partner abuse? Or that some men who violently kill their sick wives sometimes very effectively invoke defenses such as ‘mercy killings’ and ‘suicide pacts’? Even the fact that men do that much more often than women leave their partner after a terminal diagnosis feels salient in understanding the gendered implications.
The risk of coercion extends beyond intimate partners in a society riven by ageism and anti-disability bias; what happened to the elderly in care homes during Covid is just one example. More than one fifth of those over 65 have experienced physical, emotional, financial or sexual abuse. There are family members who will find ways – perhaps very subtly, even unintentionally – to hint to people with a terminal diagnosis who need 24-hour care that they should choose assisted dying. How would that make you feel? Nearly half of the people who chose assisted dying in Oregon in 2022 concerns raised about it being a burden.
Then there is the internal pressure that comes from the feeling that they should do it to spare their relatives difficulties and financial consequences: where the right to die becomes the duty die. That message will be reinforced at a societal level; Time columnist Matthew Parris recently argued in a generally condemned column that assisted dying could help offset the costs of an aging population; that there are people willing to be honest about this should be a serious cause for thought. Moreover, Palliative care doctors talk about how the desire to die is unstable, and often decreases in terminally ill patients after an initial diagnosis, and can be influenced by depression, which is difficult to diagnose.
The second factor that changed my mind is the international evidence that once you gently push open the door to assisted suicide, it is very difficult to prevent it from swinging wide open.
The most commonly cited example is Canada, where a limited form of medical assistance in dying (MAiD) existed legalized in 2016 for people with “serious and irreversible medical conditions” with guarantees about its limited scope. Today, this definition is interpreted to also include a person with severe sensitivities to chemicals do not have access to adequate housing of the state, and there are reports from officials promoting assisted dying to people with disabilities who apply for government assistance and to medical professionals who try to force people to do so. A parliamentary committee has recommended that MAiD should be extended to some sick children and it is expected to be expanded people with a chronic mental illness. In the Netherlands, euthanasia is an option for people who are autistic and lonely and is about to be expanded to children of all ages. In Oregon, where the law has remained more stable today, conditions are terminal include arthritis and anorexia.
Proponents argue that adequate safeguards are possible; the last bill of the House of Lords proposed declaration by two doctors that a person has the capacity to decide to end his own life and has done so without coercion or coercion, signed by a family judge of the Supreme Court. But this disappears upon closer examination. Medical professionals are not trained in detecting coercive control and are not necessarily good at detecting it; judges will have limited evidence to make their own decision. In the family courts, judges may fail to detect coercive control even when confronted with detailed evidence about intrafamilial relationships. Narcissistic abusers can be very adept at fooling professionals. What level of outside influence is considered too much, how is it measured, and how confident should a judge be given that life and death are at stake, making the evidentiary threshold commonly used in family courts inappropriate ?
In the Debate in the House of Lordsthere was a clear inability to address these detailed concerns. Some argued that there is no evidence of problems abroad, as if coercion-influenced wrongful deaths would magically be revealed after the fact. You only have to look at the struggle to reveal the true number of hidden murders of women by their abusers to understand the naivety of that, and somewhere in Oregon the system is simply not set up to detect wrongful deaths. With brutal utilitarian honesty, former Supreme Court President Lord Neuberger acknowledged that there had been abusebut argued that the benefits for those who act autonomously would outweigh these.
We live in a social media-driven world characterized by excessive moral certainty, where powerful individual stories that evoke strong emotions can dominate the discourse at the expense of the voiceless. There is a real risk that a law will be passed without addressing these devastating concerns. Assisted dying is not a right-left issue, but it is an increasingly prevalent issue more support from MPs on the left, including Keir Starmer, and a Labor government could feel under pressure to make major reforms that don’t cost money, given its self-imposed budget constraints. That’s why voices like Streeting’s and Sturgeon’s are so important; we urgently need politicians who are willing to acknowledge that assisted dying is one of the most complex and fraught ethical questions they will ever have to answer.